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NCOA Releases New Resource to Help You Achieve Medicare Reimbursement for Your Diabetes Self-Management Program

9/2/2019 - Kathleen Cameron, Cora Plass

The Challenge

Definitions

Diabetes Self-Management Education and Support (DSMES) Services. The term used in the 2017 National Standards for DSMES to refer to the ongoing process of supporting individuals with diabetes to increase their knowledge, skills and ability for self-care.

Diabetes Self-Management Program (DSMP). The term used for the six-week group Diabetes Self-Management Education Program originally developed at Stanford University and managed by the Self-Management Resource Center (SMRC).

Diabetes Self-Management Training (DSMT). The term used by the Centers for Medicare & Medicaid Services (CMS) to describe “educational and training services furnished . . . to an individual with diabetes by a certified provider . . . in an outpatient setting.” DSMT programs must meet the National Standards for DSMES and be accredited by a national accrediting organization approved by CMS.

Many community-based organizations (CBOs) offer the Diabetes Self-Management Program (DSMP), despite not being reimbursed for providing the service. Consequently, these CBOs can schedule only a small number of workshops, reaching fewer people than they would if they had funding that enabled them to provide additional workshops. Without reliable funding to support diabetes self-management education, CBOs may find it difficult, if not impossible, to grow and sustain this valuable service.

DSMT Information Resource

Fortunately, there is a pathway to the long-term sustainability of DSMP for CBOs. However, navigating that pathway requires that CBOs meet specific requirements to receive national accreditation of their diabetes self-management education and achieve reimbursement for the Medicare Part B Diabetes Self-Management Training (DSMT) benefit. To help CBOs meet the complex requirements for accreditation and reimbursement, NCOA is pleased to announce the release of the DSMT Information Resource.

This new resource provides valuable information about planning, implementing and sustaining an accredited Diabetes Self-Management Education and Support (DSMES) program through reimbursement of the DSMT benefit, using DSMP as the curriculum. The resource also contains detailed guidance for meeting the 2017 National Standards for DSMES, which define timely and quality evidence-based DSMES services that must be provided to meet the Medicare DSMT requirements.

Highlights of the DSMT Information Resource:• National accreditation overview• Medicare requirements for DSMT reimbursement • Medicare codes, units and rates• Medical Nutrition Therapy• 2017 National Standards and application to DSMP as the curriculum for a DSMES program• Sample Policy and Procedure Manual• Documentation flow and sample forms• Practical steps for developing, implementing and sustaining a DSMT Program

A Ripe Opportunity

Approximately 25 percent of adults 65 and older have diabetes with the prevalence of the condition expected to grow as the number of older adults grows. Diabetes can cause long-term complications and disabilities and is the seventh leading cause of death in the U.S. (CDC 2017 National Diabetes Statistics Report)

There is ample evidence that DSMES services improve diabetes outcomes, lower the risk for complications, and reduce hospital admissions. Yet, far too few Medicare beneficiaries receive the DSMT benefit. The gap between the need for services and the number of Medicare beneficiaries who have access to DSMES programs presents a ripe opportunity for CBOs to offer DSMT. CBOs can play an integral role in expanding the use of the Medicare DSMT benefit among older adults to help them age with dignity and independence in their own homes and communities. Additionally, CBOs that offer DSMT are well-positioned to help health plans and health care providers improve patient outcomes, as well as their bottom line. Creating strong cross-sector partnerships between CBOs and the health care sector is an effective strategy to significantly expand and ultimately sustain DSMT as a core service.

Call to Action

NCOA, in partnership with the Administration for Community Living and the National Association of Area Agencies on Aging (n4a), encourages you to explore the new DSMT Information Resource to help you navigate the pathway toward national accreditation and Medicare reimbursement. Whether you are just getting started or further along the path, this user-friendly resource provides detailed, step-by-step guidance to support your CBO in creating a viable DSMT program with long-term sustainability.